Healthcare Provider Details

I. General information

NPI: 1659750479
Provider Name (Legal Business Name): ANN KEATING INTEGRATIVE NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 SHAKER DR STES 103 AND 203
COLUMBIA MD
21046-1200
US

IV. Provider business mailing address

13321 DOVEDALE WAY APT G
GERMANTOWN MD
20874-4457
US

V. Phone/Fax

Practice location:
  • Phone: 301-704-2909
  • Fax:
Mailing address:
  • Phone: 301-704-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX3674
License Number StateMD

VIII. Authorized Official

Name: ANN KEATING
Title or Position: NUTRITIONIST
Credential: CNS, LDN
Phone: 301-704-2909